Provider Demographics
NPI:1992142475
Name:KOETTER, ALLISON HAVENS (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:HAVENS
Last Name:KOETTER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:615 ELSINORE PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1457
Mailing Address - Country:US
Mailing Address - Phone:833-510-4357
Mailing Address - Fax:866-460-2997
Practice Address - Street 1:9702 STONESTREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-6808
Practice Address - Country:US
Practice Address - Phone:833-510-4357
Practice Address - Fax:866-460-2997
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2022-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYR46232083P0901X
KY54433207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine